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Mission-Blue Cross NC contract ends with no replacement

Reporter Mark Barrett explains the dispute between Mission Health and Blue Cross Blue Shield of North Carolina which could lead to the insurance provider being dropped by the health care provider in October.

This building on Long Shoals Road in Skyland is one of several Mission Health facilities around Western North Carolina.(Photo: John Boyle/jboyle@citizen-times.com)

ASHEVILLE – An agreement between Western North Carolina's largest health care organization and the state's largest private insurer that affects the lives of thousands of mountain residents expired at midnight Wednesday.

Hospitals, physicians and other health care facilities that are part of Mission Health are now outside the Blue Cross Blue Shield of North Carolina network of providers.

How long that will continue is anyone's guess, but statements from both sides to the dispute this week suggest they are not on the verge of kissing and making up.

The agreement set the amounts Blue Cross NC paid Mission for X-rays, surgeries, routine physician visits or other health care services for those with Blue Cross NC insurance. Its expiration means many who are insured by Blue Cross NC will have to pay more if they want to get care from Mission Health providers.

An exception is emergency care. Customers' share of the bill is the same whether they go to an emergency room at a Mission hospital or another hospital.

The end of the contract also removes a barrier to talks to write a new one. Blue Cross NC's policy is not to negotiate with a health care provider once the provider gives notice of termination of an existing contract, but the insurer said the policy does not apply once a contract ends.

Mission Health gave a termination notice July 5, saying its existing agreement with the insurer would mean it would get no rate increase indefinitely unless it ended the contract. There have apparently been no negotiations between the two sides since.

Blue Cross NC and Mission officials said they had negotiated for months without coming to terms on a new contract. The main issue was how much, or whether, the rates for payments Blue Cross NC makes to Mission for patient care would increase.

Neither side gave any indication this week as to when or whether talks might resume. Both organizations have received public pressure to work out a deal.

Even without an agreement with Mission, "Our customers still have hundreds of options for in-network care" at other providers in the region, said Brad Wilson, CEO of Blue Cross NC. "That's important. While Mission is walking away, other providers are proactively working with us to make sure our customers get the care they need."

"It is important that everyone is aware that you can keep your doctor and you can always choose Mission Health," he said. He encouraged people to use online methods or to take advantage of "our generous charity care and discount plans."

Paulus said Mission will now focus on "helping people who need care and people who are evaluating alternative health insurance options in the marketplace."

Mission said in a statement that for many patients, its providers "are the only reasonable choice due to the patient's condition" and said it will help patients "use the legal protections available to them if (Blue Cross NC) refuses to follow state and federal law" on access to care.

Not everybody

Some types of care at Mission Health facilities will still be covered at Blue Cross Blue Shield NC's in-network rates, according to information from the organizations:

--Emergency room care.

--Blue Cross federal employees' care is in-network until Nov. 16.

--Blue Cross NC customers who are pregnant or have a chronic medical condition may qualify for a program that allows people to keep their current physician and other providers even if they are out-of-network. Those with questions can call the number on the back of their insurance card and Mission is offering help at StandWithMission.org/Resources or by calling (828)412-6363.

--Physical therapy services from CarePartners remains in network until March 3.

--Care for those with Blue Cross Medicare Supplement health plans. However, Mission Health is out of network for people with Blue Medicare HMO/PPOS, often called Medicare Advantage.

--State regulations say an insurance carrier cannot unduly delay care because of a lack of access to services. Mission says that means some people will be able to see its providers at in-network rates. It is not clear just how the rules will be applied.

Now what?

Information about providers in the Blue Cross NC network is available at bcbsnc.com/findadoctor. People who want to speak to a Blue Cross NC employee in person can visit the insurer's retail location at 1854 Hendersonville Road, Suite C.

More information from the insurer is available via www.bcbsnc.com/wnc or by calling 1-800-446-8053. Those insured by Blue Cross NC can also call the number on the back of their insurance card.

Mission has set up a website with information on the dispute, www.standwithmission.org, and a telephone number people can call with questions: 828-417-0480.